Organization
HAVANA LTC PHARMACY INC
Active
Other names
HAVANA LTC PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
YAMILET CRUZ (OWNER)
(813) 875-5914
Entity
Organization
Contact information
Practice address
3818 S HIMES AVE STE 1, TAMPA, FL 33611-1413
(813) 875-5914
(813) 875-5924
Mailing address
3818 S HIMES AVE, SUITE #1, TAMPA, FL 33611-1413
(813) 875-5914
(813) 875-5924
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH21424
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030971100
—
FL
01
—
2005033
PK
—
Enumeration date
02/03/2006
Last updated
12/13/2016
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